2022 Sweetwater Surfers Swim Team Release & Indemnification Form

Swim Team Release Form for SWCC

A separate form was completed for SHRSL. This form is required for use of Sweetwater Country Club facilities. A separate form is required for each swimmer before they will be allowed to attend practice.
Review Release Form and continue below to complete your form:
Today's Date *

Month Day Year
Date
This "Release" is made this
day of,
202
Guardian's Full Name *
Relationship to Swimmer
The Swimmer's Full Name *

Child's First Name Child's Last Name
Age Group
Member Number (SWCC Number, or N/A)
Medical Form Information
Please list any allergies:
Immunizations:
Medical History (i.e. epilepsy, diabetes, etc.)
Preferred Hospital:
Family Physician:
Physician's Phone Number:
Please enter a valid phone number.
Insurance Company:
Insurance Company Phone Number:
Please enter a valid phone number.
Name of Policy Holder:
Policy Holder Date of Birth:

Month Day Year
Date
Policy Number or ID:
Group Number:
Emergency Contact #1 Name:
Emergency Contact #1 Relationship to Swimmer:
Emergency Contact #1 Phone Number:
Please enter a valid phone number.
Emergency Contact #1 Alternate Phone Number:
Please enter a valid phone number.
Emergency Contact #2 Name:
Emergency Contact #2 Relationship to Swimmer:
Emergency Contact #2 Phone Number:
Please enter a valid phone number.
Emergency Contact #2 Alternate Phone Number:
Please enter a valid phone number.
Emergency Contact #3 Name:
Emergency Contact #3 Relationship to Swimmer:
Emergency Contact #3 Phone Number:
Please enter a valid phone number.
Emergency Contact #3 Alternate Phone Number:
Please enter a valid phone number.
Emergency Contact #4 Name:
Emergency Contact #4 Relationship to Swimmer:
Emergency Contact #4 Phone Number:
Please enter a valid phone number.
Emergency Contact #4 Alternate Phone Number
Please enter a valid phone number.
Signature (please sign) *

Clear
Email Address to Receive a PDF of Your Completed Form: *
example@example.com
Should be Empty:

Swim Team Release Form for SWCC

Medical Form Information